Perceived and reported access to the general practitioner: an international comparison of universal access and mixed private/public systems.

Timely and convenient access to primary healthcare is essential for the health of the population as delays can incur additional health and financial costs. Access to health care is under increasing scrutiny as part of the drive to contain escalating costs, while attempting to maintain equity in service provision. The objective was to compare primary care services in Republic of Ireland and Northern Ireland, and to report on perceived and reported access to GP services in universal access and mixed private/public systems. A questionnaire study was performed in Northern Ireland (NI) and the Republic of Ireland (ROI). Patients of 20 practices in the ROI and NI were contacted (n = 22,796). Main outcome measures were overall satisfaction and the access to GP services. Individual responses and scale scores were derived using the General Practice Assessment Questionnaire (G-PAQ). The response rate was 52% (n = 11,870). Overall satisfaction with GP practices was higher in ROI than in NI (84.2% and 80.9% respectively). Access scores were higher in ROI than in NI (69.2% and 57.0% respectively) Less than 1 in 10 patients in ROI waited two or more working days to see a doctor of choice (8.1%) compared to almost half (45.0%) in NI. In NI overall satisfaction decreased as practice size increased; 82.8%, 80.4%, and 75.8%. In both systems, in large practices, accessibility is reduced when compared to smaller practices. The faster access to GP services in ROI may be due to the deterrent effect of the consultation charge freeing up services although, as it is the poorest and sickest who are deterred by the charge this improved accessibility may come at a significant cost in terms of equity. The underlying concern for policy makers centres around provision of equitable services.

Validity of the Perceived Health Competence Scale in a UK primary care setting.

The Perceived Health Competence Scale (PHCS) is a measure of self-efficacy regarding general healthrelated behaviour. This brief paper examines the psychometric properties of the PHCS in a UK context. Questionnaires containing the PHCS, the SF-36 and questions about perceived health needs were posted to 486 patients randomly selected from a GP practice list. Complete questionnaires were returned by 320 patients. Analyses of these responses provide strong evidence for the validity of the PHCS in this setting. Consequently, we conclude that the PHCS is a useful addition to measures of global self-efficacy and measures of self-efficacy regarding specific behaviours in the toolkit of health psychologists. This range of self-efficacy assessment tools will ensure that psychologists can match the level of specificity of the measure of expectancy beliefs to the level of specificity of the outcome of interest.

An Innovative Model for the Provision of Practice Learning Opportunities in Family and Child Care: Newry Student Unit, Southern Health and Social Care Trust.

This article describes the work of Newry Student Unit which operates in the Southern Health and Social Care Trust. The background to the unit is outlined and its development is discussed in the context of practice learning provision in Northern Ireland. The operation of the unit in providing Family and Child Care practice learning opportunities (PLOs) for student social workers is outlined and findings from evaluation questionnaires completed by students, college tutors and team leaders are presented. The paper highlights both the advantages and disadvantages of this model of PLO provision and concludes that it is a valuable resource for practice learning. Proposals for the development of the unit are discussed and it is suggested that the model has the potential be replicated in other areas of Northern Ireland.

The police officer's terrorist dilemma: Trust resilience following fatal errors

Suicide attacks have raised the stakes for officers deciding whether or not to shoot a suspect ('Police Officer's Terrorist Dilemma'). Despite high-profile errors we know little about how trust in the police is affected by their response to the terrorist threat. Building on a conceptualisation of lay observers as intuitive signal detection theorists, a general population sample (N= 1153) were presented with scenarios manipulated in terms of suspect status (Armed/Unarmed), officer decision (Shoot/Not Shoot) and outcome severity (e.g. suspect armed with Bomb/Knife; police shoot suspect/ suspect plus child bystander). Supporting predictions, people showed higher trust in officers who made correct decisions. reflecting good discrimination ability and who decided to shoot, reflecting an 'appropriate' response bias given the relative costs and benefits. This latter effect was moderated by (a) outcome severity, suggesting it did not simply reflect a preference for a particular type of action, and (b) preferences for a tough stance towards terrorism indexed by Right-Wing Authoritarianism (RWA). Despite loss of civilian life, failure to prevent minor terror attacks resulted in no loss of trust amongst people low in RWA. whereas among people high in RWA trust was positive when police erroneously shot all unarmed suspect. Relations to alternative definitions of trust and procedural justice research are discussed. Copyright (C),. 2007 John Wiley & Sons, Ltd.

Trust considerations on attitudes towards online purchasing: The moderating effect of privacy and security concerns

The research examines the relationships between three common trust considerations (vendor, Internet and third parties) and attitudes towards online purchasing. The study incorporates privacy and security concerns as a moderating variable and finds that these relationships vary depending on the level of concerns a consumer has when purchasing online. The study suggests that "fears" surrounding the Internet as a place to do business still hinder the use of it for e-commerce purposes, but that the presence of a reputable agent might in some manner mitigate this risk. In the context of business to consumer relationships trust in the vendor is important for the consumer to accept any risk associated with a transaction. Theoretical implications for online customer behavior theory are also discussed. © 2009 Elsevier Inc.

The Philosophy and Practice of Interpretivist Research in Entrepreneurship Quality, Validation, and Trust

Knowledge production in entrepreneurship requires inclusivity as well as diversity and pluralism in research perspectives and approaches. In this article, the authors address concerns about interpretivist research regarding validity, reliability, objectivity, generalizability, and communicability of results that militate against its more widespread acceptance. Following the nonfoundationalist argument that all observation is theory-laden, context specific, and that there are no external criteria against which to assess research design and execution and the data produced, the authors propose that quality must be internalized within the underlying research philosophy rather than something to be tested upon completion. This requires a shift from the notion of validity as an outcome to validation as a process. To elucidate this, they provide a guiding framework and present a case illustration that will assist an interpretivist entrepreneurship researcher to establish and demonstrate the quality of their work.

The ‘Us’ in Trust: Who Trusts Northern Ireland’s Political Institutions and Actors?

This article examines levels of interest and trust among the public in relation to Northern Ireland's newly established political institutions and actors, through an analysis of the results of the 2007 Northern Ireland Life and Times Survey (NILT). It is important to reveal the specific groups of people with the highest levels of political disenchantment, particularly in the context of the longer-term stability of the Northern Ireland Assembly and Executive, since the willingness of the electorate to have faith and trust in the workability of these political institutions and in the various political actors in whose custody they lie is considered vital.